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Seafarer Application Form - Confidence Shipping

The document is a seafarer application form for Confidence Shipping Co. Pvt. Ltd, which includes sections for personal information, documents details, sea service details, qualifications, medical declarations, and references. Applicants must confirm the validity of their documents and certify the accuracy of the information provided. The form also includes a declaration of consent for sharing application details during the recruitment process.

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harshprxxt.12
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43 views3 pages

Seafarer Application Form - Confidence Shipping

The document is a seafarer application form for Confidence Shipping Co. Pvt. Ltd, which includes sections for personal information, documents details, sea service details, qualifications, medical declarations, and references. Applicants must confirm the validity of their documents and certify the accuracy of the information provided. The form also includes a declaration of consent for sharing application details during the recruitment process.

Uploaded by

harshprxxt.12
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

CONFIDENCE SHIPPING [Link].

LTD
RPSL- MUM-071 VALID TILL 17.12.2026
A-401, REMI BIZ COURT, VEERA DESAI ROAD, ANDHERI (WEST) MUMBAI- 400053
Email:hr@[Link] Contact: +91 22 4619 1734 / 022 4619 1719
WEBSITE: [Link]

SEAFARER APPLICATION FORM

Personal Information
Date of Availibility
Post Applied For
Full Name (as per Family name : Given name :
passport)
Date of Birth Place of Birth:
Marital status Single Married Divorced Seperated
Nationality
Address

City/State/Pin
Phone Number
Email
HEIGHT/WEIGHT Height: Weight:

NEXT OF KIN / NOMINATION DETAILS:-


NOK Name
Relationship
NOK Address

MOB Number

Documents Details
Document Type Document Issuing Date of Issue Date of Expiry
Number Authority
PASSPORT
SEAMAN BOOK
US VISA
AUS MCV
INDOS NUMBER
YELLOW FEVER
SID
COVID DOSES 1st Dose – (Yes/No) - 2nd Dose – (Yes/No) - Booster Dose – (Yes/No)
Certificate of Competency: For Ratings : COP and WK certificate to be written
CLASS/ ISSUING EXPIRY
NUMBER ISSUE DATE
GRADE COUNTRY DATE
COC
GOC GMDSS
GMDSS
ENDORSEMENT
OIL DCE
CHEMICAL
DCE
GAS DCE

Courses Details:
COURSES CERTIFICATE PLACE OF DATE OF DATE OF EXPIRY
NUMBER ISSUE ISSUE

Sea Service Details (Last 5 Years)


COMPANY NAME( SHIP VESSEL VESSEL RANK GRT/BHP ENGINE SIGN ON SIGNOFF
MANAGER) NAME TYPE DETAILS DATE DATE
Qualifications (For officers 10th STD not applicable)
QUALIFICATION INSTITUTION NAME BOARD PASSING YEAR PERCENTAGE
10TH STD / SSC
12TH STD / HSC
Pre-sea Training
Any other
Qualification

Medical Declaration Questions


Question Yes/No
Is there is any medical history of any of the following
Have i ever signed off a ship due medical reason?
Have i undergone any medical operations in the past?
Have i consulted a doctor in last 12 month of an illness/accident?
Do i have any health disability problems now?
If answer to any of the question is YES give details,

TWO REFERENCE OF COLLEAGUES


NAME & SEAFARER RANK Mobile Number
1.
2.

DECLARATION OF CONSENT
I confirm that the validity of all above-mentioned documents covers the contract duration +3 months
or +6 months for passport.

I hereby certify that the information given in my application form, including sea service details, is
true and complete to the best of my knowledge. Any false or misleading statement in the application
& submitted documents will lead to my dismissal from the employment without notice or payment.

I consent to Confidence Shipping Pvt. Ltd to share my application form details for the purpose of the
recruitment process and not for disclosing it for any other purpose. .

Signature Date

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